The AHA Guidelines and Scientifi c Statements Handbook
Table 4.1. Continued
Interventions
- Offer individual and/or small group education and counseling on adjustment to heart disease, stress management, and health-related
lifestyle change. When possible, include family members, domestic partners, and/or signifi cant others in such sessions. - Develop supportive rehabilitation environment and community resources to enhance the patient’s and the family’s level of social support.
- Teach and support self-help strategies.
- In concert with primary healthcare provider, refer patients experiencing clinically signifi cant psychosocial distress to appropriate mental
health specialists for further evaluation and treatment.
Expected outcomes
- Emotional well-being is indicated by the absence of clinically signifi cant psychological distress, social isolation, or drug dependency.
- Patient demonstrates responsibility for health-related behavior change, relaxation, and other stress management skills; ability to obtain
effective social support; compliance with psychotropic medications if prescribed; and reduction or elimination of alcohol, tobacco, caffeine, or
other nonprescription psychoactive drugs. - Arrange for ongoing management if important psychosocial issues are present.
Physical activity counseling [37,48–50]
Evaluation
- Assess current physical activity level (e.g., by questionnaire, pedometer) and determine domestic, occupational, and recreational needs.
- Evaluate activities relevant to age, gender, and daily life, such as driving, sexual activity, sports, gardening, and household tasks.
- Assess readiness to change behavior, self-confi dence, barriers to increased physical activity, and social support in making positive
changes.
Interventions
- Provide advice, support, and counseling about physical activity needs on initial evaluation and in follow-up. Target exercise program to
meet individual needs (see Exercise Training section of table). Provide educational materials as part of counseling efforts. Consider exercise
tolerance or simulated work testing for patients with heavy labor jobs. - Consistently encourage patients to accumulate 30–60 minutes per day of moderate-intensity physical activity on ≥5 (preferably most) days
of the week. Explore daily schedules to suggest how to incorporate increased activity into usual routine (e.g., parking farther away from
entrances, walking ≥2 fl ights of stairs, and walking during lunch break). - Advise low-impact aerobic activity to minimize risk of musculoskeletal injury. Recommend gradual increases in the volume of physical
activity over time. - Caution patients to avoid performing unaccustomed vigorous physical activity (e.g., racquet sports and manual snow removal). Reassess
the patient’s ability to perform such activities as exercise training program progresses.
Expected outcomes
- Patient shows increased participation in domestic, occupational, and recreational activities.
- Patient shows improved psychosocial well-being, reduction in stress, facilitation of functional independence, prevention of disability, and
enhancement of opportunities for independent self-care to achieve recommended goals. - Patient shows improved aerobic fi tness and body composition and lessens coronary risk factors (particularly for the sedentary patient who
has adopted a lifestyle approach to regular physical activity).
Exercise training [17,48–51]
Evaluation
- Symptom-limited exercise testing prior to participation in an exercise-based cardiac rehabilitation program is strongly recommended. The
evaluation may be repeated as changes in clinical condition warrant. Test parameters should include assessment of heart rate and rhythm,
signs, symptoms, ST-segment changes, hemodynamics, perceived exertion, and exercise capacity.